Provider Demographics
NPI:1396880472
Name:RIVERVIEW CARDIAC DIAGNOSTIC ASSOCIATES P.A.
Entity type:Organization
Organization Name:RIVERVIEW CARDIAC DIAGNOSTIC ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-1203
Mailing Address - Street 1:PO BOX 8785
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8785
Mailing Address - Country:US
Mailing Address - Phone:732-530-1203
Mailing Address - Fax:732-530-1204
Practice Address - Street 1:1 RIVERVIEW PLZ
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1864
Practice Address - Country:US
Practice Address - Phone:732-530-1203
Practice Address - Fax:732-530-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34768207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3211002Medicaid
NJ410581Medicare ID - Type UnspecifiedLEGACY